Individual
DR. CHARLENE EICKHOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1405 NE BROADWAY, SUITE # 200, PORTLAND, OR 97232-1497
(503) 288-5516
Mailing address
1405 NE BROADWAY, SUITE # 200, PORTLAND, OR 97232-1497
(503) 288-5516
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY1323
OR
Other
Enumeration date
03/16/2009
Last updated
03/16/2009
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